Provider Demographics
NPI:1598283731
Name:POLING, CHELSEY (PT)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:POLING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:
Other - Last Name:PROVENCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:800 DENOW RD STE U
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534
Practice Address - Country:US
Practice Address - Phone:609-737-8130
Practice Address - Fax:609-737-8131
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026270225100000X
NJ40QA01901700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist